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Taiwan addresses issue of mental health

When it comes to suicide prevention, everyone should be responsible and the entire population should get involved

Taiwan addresses issue of mental health

An average of 10 persons take their own lives in Taiwan each day. When the Taiwan Suicide Prevention Center got inaugurated upon the initiation of the Department of Health (DOH) through the Taiwan Depression Prevention and Treatment Association on December 9, 2005, adopting the World Health Organization's slogan "Saving Lives, Restoring Health," attention was called to Taiwan's suicide statistics.

The Department of Health through the center headed by Dr. Lee Ming-bing is addressing the need for national data on suicide, which is a public health concern, as well as clamor for analyses of issues related to suicide and mental health from a medical perspective. But as stressed by Dr. Lee, "When it comes to suicide prevention, everyone should be responsible and the entire population should get involved." The center chose to launch its first publication on suicide prevention on the day it was inaugurated.

The Department of Health recorded 3,468 suicides in Taiwan in 2004. Of these cases, 2,351 were males and 1,117 were females, indicating men were three times more prone to take their own lives. When compared to records from 2003, the total marked an increase of suicides by 273. The ages ranging from 20 to 29 and 65 and up emerged as the most vulnerable. As for occupations, men and women in show business, artists, businessmen, military personnel and professionals seemed at higher risk.

Veteran entertainer Ni Min-jan's suicide gripped Taiwan's population for several weeks last year. The tragedy precipitated media coverage frenzy, later triggering debates over the propriety and decency of the intrusion into the privacy of the victim and those close to him.

According to the World Health Organization, there is always the possibility that publicity about suicide might make the idea of suicide seem normal although cases singled out are usually a departure from usual patterns.

According to information gathered by the Taiwan Depression Prevention and Treatment Association, which is in charge of running the Taiwan Suicide Prevention Center, the victims themselves or their immediate family members often suffered from serious depression previously. Or they could be patients suffering from mental illnesses. Serious health problems, alcohol or drug abuse, past suicide attempts, loss of job, and living alone appeared over a period of time in the case histories.

On a short-term basis, the suicidal individuals were dealing with separation from or loss of a loved one. An upset in economic standing could also deal a heavy blow leading to despair. Easy cash advances offered by banks and credit card companies nowadays make many people unwittingly pile up enormous debts impossible to pay.

Societal factors could also trigger suicide. Rise in unemployment saw a commensurate increase in suicide incidence in 2000. The September 21 earthquake likewise led to more suicides in the Nantou area in 1999.

Suicides caused by specific problems do not necessarily solve them. Families and friends of victims often have difficulty stepping out of the shadow and pain. The recriminations and blames leave surviving loved ones and friends feeling very guilty.

"While the establishment of the Taiwan Suicide Prevention Center was a recognition of the seriousness of the suicide problem in Taiwan, with the local prevalence catching up with statistics in developed countries, it should not imply that the people in Taiwan have gone suicidal in general," said Dr. Liao Shih-cheng, vice CEO of the center. "Don't panic but stay always on the alert," he appealed to the public.

Liao acknowledged that suicide has ranked No. 9 among the top 10 causes of death in Taiwan in recent years just like in many developed countries. Actually it has made the top 10 list for eight consecutive years.

Suicide statistics gathered by the Department of Health have indicated a rising trend in the last 10 years. The suicide rate in 1993 came up to 6.2 cases for every 100,000 persons. By the year 2004, the figure had increased to 15.3 suicides for every 100,000 persons. Young and able-bodied men, often counted upon to be family pillars, constituted the bulk of the suicides, too, underlying a reckless throwing away of lives and calling attention to an overall social and national problem. Worthy of note was the fact that a good number of those who committed suicide belonged to the 25 to 64 age bracket.

"Statistics reveal that the highest incidence of suicides can be found among the elderly or senior citizens though," pointed out Liao. "However, cases of young people taking their own lives tend to grab public attention more easily."

Liao remarked that the community has a crucial role to play in suicide prevention. Volunteers can visit and help look after the elderly people, whose children are too busy making a living. Senior citizens with chronic illnesses, for example, need to be reminded about regular medication intake. Deteriorating health condition, loneliness and feeling of hopelessness have a way driving old people into the abyss of despair.

The suicide rate in Taiwan stands today at an average of 10 per day. Often, cases showed histories of earlier attempts. Almost 80 percent of these victims had records of mental illnesses with depression as the most common. Financial difficulties, heavy responsibilities and involvement in unlawful activities to the point of no return paved the road to suicide.

Liao, one of a little over 1,000 licensed psychiatrists in Taiwan, further observed: "Causes of suicides are usually overly simplified in reports. The victim probably had a spat with the spouse. Oftentimes, however, a combination of factors drove a person to commit suicide."

Suicide prevention entails determining first who are most likely to take their own lives. Liao pointed out: "Those who threaten to kill themselves should not be taken lightly. Those who have attempted to do it should be guarded against repeating it."

Liao, however, admitted that frequent threats of suicide sometimes drove people around to ultimately ignore the would-be suicides. Individuals who felt abandoned at this point just went ahead with taking their own lives.

According to Liao, the biological factor in would-be suicides is not to be overlooked. Some people are born with the "vulnerability" to depression. But again, the social environment may have a bearing on a person's behavior.

Nowadays, students complain about study and exam pressures while those holding jobs gripe about stress at the workplace. Relationships gone wrong also affect people emotionally. Human relationships in the everyday lives of the population can be very complicated.

Liao warned against the putting of a stigma on those with mental health problems. If suicide prevention is to work, there should be a lot of love and compassion in the community, he said. He then pointed to the logo of the new Taiwan Suicide Prevention Center, showing two hands cupping a heart. A key is about to open a heart-shaped lock.

"If someone refuses to see a psychiatrist due to difficulty in acknowledging mental illness or anxiety disorder," said Liao, "then find a respected doctor in the community or recommend a general practitioner."

The Taiwan Suicide Prevention Center with a 16-member staff has been establishing and securing a reliable database on mental health in Taiwan. The center should eventually be relied upon in pinpointing and dealing with suicide and relevant issues.

The Taiwan Depression Prevention and Treatment Association, which is running the center, has a lot of experience to fall back on. Their recommendations on how best to proceed in the campaign to prevent suicides are to serve as standard reference. Doctors and mental health workers are still figuring out how to walk on sensitive ground having to do with individual privacy.

"We are building links with the emergency rooms, enabling us to have access to information on suicide cases rushed to the hospitals for future monitoring and suicide prevention," said Liao. "Unsuccessful suicide cases have a high possibility of making similar attempts later."

While coordinating with counties and cities in promoting the building of a network of concern, the center must deal with certain issues. Liao remarked that the medical record confidentiality issue due to the stigma of having mental health problem accounts for the difficulty in following up and monitoring the condition of patients. They may resent intrusion into their privacy.

The center hopes to eventually have their people go out and disseminate the latest information on depression and suicide prevention. Special training classes are to be offered through website, enabling even the layman to conveniently acquire up-to-date knowledge. Its ultimate goal is to promote an outlook characterized by "cherishing of life and spreading of boundless hope."

As for the medical treatment introduced as part of suicide prevention, the patient remains the most important. The family, however, has a supportive role to play in the person's recovery. The community likewise is also where a basic support group comes from when family members cannot be always around.

Experts are saying that psychological studies emphasize the soundness of staying in a happy and healthy mood. Ultimately prevention is much better than cure. If people can lead happy lives, having "a sound mind in a healthy body" ("men sana in corpore sano," as the saying goes), then there will be no need to seek help for major depression and other mental health problems.

In recent years, attention is increasingly being given to prevention of mental illnesses in Taiwan. More and more people, including high-profile celebrities, are openly talking about their depressive disorder, citing all kinds of reasons for the condition of their mental health. Awareness means a step closer towards either prevention or cure. Those who are subjected to perennial stress and pressure are reminded to act and check deteriorating mental health. Those confronted with disorders are encouraged to get medical attention and seek therapy.

It is important to build on the strengths and virtues of young people, enabling them to cope with difficulties when they go out into the society later, according to the center.

"There is an urgent need to diagnose and treat those suffering from depression while in the early stage to prevent further deterioration, which renders cure more complicated," said Liao.

The center is likewise trying to find out the most common methods of suicide and recommend ways to deal with them. The ways of committing suicide include: drug overdose, cutting of wrist, drinking pesticide, leaping from a high building, hanging, use of gas, self-immolation and so forth.

"In countries like Sri Lanka, the sale of agricultural pesticides is regulated as part of the suicide prevention effort," said Liao. "But equally important is knowledge of first aid against pesticide poisoning."

Worth looking into is the problem of alcoholism, said Liao. Excessive alcohol dependence can lead to suicide. Stricter regulation on alcohol sale invites discussion.

In order to prevent the suicide-prone from carrying out a horrifying death plunge from the top of a building, which was what the beautiful but broken-hearted advertising model daughter of a show business personality did last year, the putting up of sure-fire barriers on rooftops should perhaps be more strictly enforced.

Mental illnesses cause lost years of healthy life. Major depressive disorder, alcohol use, schizophrenia, self-inflicted injuries, bipolar disorder, drug use, obsessive-compulsive disorders and violence are illnesses, which respond to different treatments. Patients are not necessarily committed to psychiatric hospitals. Institutionalized treatment, which could consist of just putting patients in straightjackets and locking them up in mental asylums, is being replaced with other more effective therapy and cure.

"Let us not discriminate against those with mental illnesses," said Liao. "The law is against indiscriminately calling someone crazy. A person who talks to himself is not necessarily insane. Only a mental health professional can make the diagnosis and validation through internationally accepted and standardized testing. The seemingly mentally ill who roams the street can be forcibly rounded up with help from the police or fire department only if he or she shows destructive or harmful behavior."

The Taiwan Suicide Prevention Center (tel. 02-2555-0500) is located at 3F, 40 Jhengzhou Road in Taipei. Its website is at: